Information for Schedulers

Information for Schedulers or Referral Sources

General Information--Dr. Curling:

Information for Schedulers

New Patient Evaluation Options

Dr. Curling offers an array of new patient evaluations, tailored to various needs and situations. Basically, non-medicolegal cases can be seen for a general neurosurgical consult (NP0) and the appropriate medical issues will be addressed and further follow up and treatment offered as appropriate. Note carefully, however, that if scheduled for this level of service, Dr. Curling will specifically not address any medicolegal issues (work status, ratings, causality, etc.). Therefore, if being referred for any type of medicolegal claim (accepted or denied workers' comp claim, MVA or other personal injury, etc.) for which the requesting party is in need of such information or potentially will require Dr. Curling to serve as an expert witness regarding the issues of the case, then a higher level of service must be requested (see below).

For medicolegal claims, three levels of service for new patient evaluations are available. If the patient is within 4 months of the date of injury at the time of scheduling request to our office, Dr. Curling will schedule an "Early Intervention Evaluation" (NP1), which will include a comprehensive evaluation of all appropriate medical and medicolegal issues and will usually be followed by further evaluation and treatment in our office, if determined to be necessary (and pending approval of the treatment plan by the appropriate party). If it has been greater than 4 months since the date of injury, the patient/claimant will be scheduled for an "Independent Medical Evaluation" (as per NC G.S. 97.27a) or "Complex Consultation/2nd Opinion" (as per NC G.S. 97-25) (NP3). Unique to North Carolina workers' compensation claims, another type of medicolegal evaluation is available if requested--"Additional Opinion on Rating" (NP2). However, an NP2 evaluation will address no issues except an impairment rating and then only if Dr. Curling deems the patient to be at MMI; as such, in the vast majority of cases, an IME is a more appropriate choice for an initial evaluation. Note that patients previously seen by Dr. Curling and being referred back for reevaluation and/or treatment after more than a one year hiatus and/or following some substantial change since being last seen (e.g., surgery) will be scheduled as an IME/Complex Consultation rather than a routine return visit. While further evaluation and treatment is usually anticipated following non-medicolegal consults or Early Intervention Evaluations (if indicated and requested), NP2 and NP3 visits are scheduled as an "evaluation only", and further treatment in our office is not anticipated, unless felt to be necessary and appropriate and agreed upon by all involved parties following review of the findings of the evaluation. A signed Memorandum of Understanding and prepayment will be required before an appointment time will be offered for any medicolegal case. To begin the referral process, a referral form needs to be completed and returned (can be requested from our office or downloaded via the links at the bottom of this page).

Also note carefully that Dr. Curling strictly limits his practice to the realm of neurosurgery and related pain conditions. He does not perform general occupational injury evaluations, nor will he address issues that he deems to be outside of his area of expertise. If evaluation by another specialist is felt to be most appropriate, Dr. Curling will facilitate that referral if desired. If it is unclear whether an evaluation of a particular patient by Dr. Curling is appropriate, we would recommend that you contact us to discuss the specifics of the situation. While Dr. Curling does not routinely require that records be submitted for review prior to requesting an appointment, he may do so in these situations in order to determine the appropriateness of a referral.

Additional Information regarding Early Intervention Evaluations

Please note that the NP1 level of visit (less than 4 months since DOI) is aimed at improving the level of service that is often seen in workers' compensation and other medicolegal cases, hopefully leading to a more expeditious and efficient resolution of these cases for the carrier, while providing a more pleasant and effective course of evaluation and treatment for the patient. Rather than the typical course of working up the ladder and bouncing from provider to provider, from ER to primary care, to urgent care, to physiatrist, to orthopedist, to physiatrist, to spinal orthopedist, to neurosurgeon, and back again, the goal is to get the spine and/or brain injured patient directly to a neurosurgeon at the outset. If surgical treatment is clearly indicated, Dr. Curling can facilitate expeditious referral to another operating spinal or cranial surgeon for that procedure. However, if non-surgical treatment appears initially to be most appropriate (as is the case in the majority of situations), then Dr. Curling will offer to coordinate care, ideally moving the patient as expeditiously as feasible to MMI. He will participate in referral for any appropriate testing or treatment and will schedule follow up visits at appropriate intervals to "maintain control" and keep an eye on the "big picture" as the patient flows through the system. While many services can be provided in the office of Neurosurgery & Pain Specialists, for services not presently available (e.g., MRI, major surgery), Dr. Curling will assist with scheduling and have the patient return to his office for follow up recommendations after the referral.

Further Evaluation/Treatment following the initial evaluation

As alluded to above, further evaluation and treatment is anticipated for all non-medicolegal referrals and for medicolegal referrals occurring within 4 months of date of injury and treatment will usually be initiated at or shortly after the initial evaluation. All IME/2nd Opinion and Additional Opinion on Rating patients are seen for "evaluation only" and no treatment will be initiated at the time of the initial appointment. However, in specific circumstances in which the IME patient/claimant is not felt to be at MMI and/or additional maintenance treatment is required to maintain MMI, Dr. Curling may be available to facilitate obtaining additional studies and providing further non-operative treatment that he has recommended. In these cases, treatment will not be initiated prior to review of the findings/recommendations by all appropriate parties (either via his written report or via communication from a case manager attending the appointment). If following review of the findings, additional evaluation and/or treatment in this office is desired, then this can be arranged after our office has been notified of such (at which point orders for recommennded studies will be provided and/or a follow up appointment arranged to initiate treatment). As noted above, if the patient is felt by Dr. Curling to be a candidate for surgical treatment, he can assist with referral to an appropriate provider for that procedure, if requested.

Case Managers

Dr. Curling appreciates the value that on site case managers typically provide, especially in worker's comp cases, and particularly in terms of facilitating communication, scheduling, and the general efficiency of the patient's course through the process. While telephonic case managers may provide some value, that value is typically far less than that which can be provided by an on site case manager. If rapid communication is going to be needed by the carrier/adjuster to facilitate approval of prescribed medications, scheduling of recommended studies, etc., then it is highly recommended that an onsite case manager be assigned to the case.

Dr. Curling realizes the importance of communicating with case managers, attorneys, and others involved with medicolegal cases. However, in order to complete the most objective evaluation possible while also encouraging the patient/claimant to feel comfortable and to enjoy the appropriate amount of privacy and confidentiality during the evaluation, Dr. Curling does not allow these individuals to accompany the patient during the evaluation. However, should a case manager be present at the appointment, he will gladly sit down with that individual and the patient immediately following the evaluation to review the initial findings and impressions and to address any questions. Please note that Dr. Curling's new patient appointments are lengthy, and probably quite a bit longer than those to which most are accustomed. As a general rule, if desired, a case manager can plan to arrive at least 30 minutes after the scheduled appointment time for NP1 appointments and 60 minutes after the scheduled appointment time for NP2 and NP3 visits in order to minimize the wait time while Dr. Curling is with the patient/claimant. While case managers are welcome to wait in our reception area (or in the rockers on the front porch on a pretty day), our office does also have a work area specifically for case managers waiting for conference following their patient's visits with our providers. If unable to attend the appointment (or in the case of telephonic case managers), a brief "Quick Response Report" that contains a summary of the recommendations can be requested to be faxed or emailed, typically within 24 hours of the appointment.

Attorneys and Expert Opinion

Dr. Curling recognizes that all patients/claimants seen for evaluation of medicolegal claims are potentially cases that will require legal testimony at some point in the future. He is available for consultation with attorneys, deposition, or other sworn testimony upon request, and will attempt to work with the requesting attorneys to accommodate these needs should they arise. Time is actually allotted on his schedule each week for these activities. Fee schedule for attorney-related activities can be provided upon requested.

It is Dr. Curling's goal to publish the reports of initial evaluations as expeditiously as possible following the appointment. Obviously, however, delays may occur due to other patient issues, illness, personal obligations, etc.. This can also occur if additional information (either records or studies) necessary to provide a complete and useful evaluation was not available at the time of the appointment. If the necessary information is not available at the time of the appointment to complete a useful evaluation, preliminary impressions will be shared with the patient (and the case manager following the appointment if present) and the report will be produced after the additional information has been provided. Dr. Curling's goal is to get reports out within 2 weeks of the appointment; if you have not received the report within that timeframe, please feel free to email him directly to let him know that you are "patiently waiting". Note that Dr. Curling dictates and produces each report and no one else in the office has any control over that process; therefore, if you are awaiting a report, it is best to contact him directly. If you have a genuine pressing deadline to receive a report (pending hearing, mediation, etc.), please relate that information to us at the time of scheduling, as Dr. Curling does make an effort to accommodate such requests.

Referral Forms

To begin the referral process, please complete and submit our referral form containing the basic demographic information. You may contact us for a form to be faxed or emailed to you, or you can download the form (in Word or pdf format) from the links below. Once the referral request is received (via fax/mail/email), our staff will contact you with additional information including a policy statement that includes more detailed information about our services and prepayment requirements (required for all medicolegal evaluations) and contains a copy of the Memo of Understanding (authorization). Once prepayment and a signed authorization have been received in our office, an appointment can be scheduled via the requesting party (adjuster, attorney, case manager, etc.). For non-medicolegal referrals (NP0), the referral form can be found at the bottom of this page (make sure to choose "non-medicolegal" form).